Liver and pancreatic enzymes explained | AST,

ALT, GGT, ALP, Amylase& Lipase

liver transaminases:

ALT = alanine transaminase or alanine aminotransferase (GPT)

AST = aspartate transferase or aspartate aminotransferase (GOT)

if you have the liver damage it's predicted

that alt and ast will be high next if

you have a biliary system problem it's

expected that ALP and GG G will be high

LP of course is alkaline phosphatase GG

T is gamma gluten meal transferase if

you have a problem with your pancreas

both amylase and lipase are expected to

be high and I've told you before that

amylase is more sensitive lipase is more

specific why isn't amylase specific

because there is also a salivary amylase

amylase is not specific for the pancreas

but lipase boy it's very specific

alt is predominantly produced from the

liver while ast can be present in many

tissues including liver skeletal muscles

heart kidneys brain even your red blood

cells so if you have a liver problem

both of them will be elevated if you

have only high AST but alt is normal

think something other than the liver

same thing here alkaline phosphatase is

present in many tissues including

hepatobiliary bone placenta kidney

gastrointestinal tract GGT is

predominantly in the hepatobiliary

system if you have a problem with the

bile ducts both AOP and GGT will be high

if you have normal gzt but high ALP

think something other than the biliary

system such as maybe bone problem again

alt is more specific for liver disease

than ast if ast is high while alt is

normal think extrahepatic maybe muscle

so if you suspect a muscle problem

please measure the Korean name kinase or

Korea and in phosphokinase which is kind

of the same stuff in liver disease alt

and ast will be high most of the time

alt is higher than ast with a major

exception which is alcoholic liver

disease where ast is higher than alt

high ALP and normal GGT think

extrahepatic such as the bone

specifically increased osteoblastic

activity if you see sudden increase in

alkaline phosphatase and gamma garuda

mole transferase think hepatocellular

carcinoma

also don't forget alcohol can raise the

gamma gluten meal transferase now let's

have some fun so question you have a

patient with jaundice anemia increased

unconjugated bilirubin only everything

else is okay including the conjugated

bilirubin the alkaline phosphatase GGG t

etc what's the diagnosis please pause

the video the diagnosis is

this is a hemolytic jaundice so if we

have our nice liver here and here is our

bile duct and biliary system where is

the problem the problem is pre hepatic

before entering the liver there is no

problem in the liver there is no problem

in the biliary system and of course

there is no problem in the pancreas okay

let's go to the second question you have

a patient with jaundice increased

unconjugated bilirubin and conjugated

bilirubin very high transaminases

alkaline phosphatase is normal or

slightly elevated what's the diagnosis

are you ready

this is hepatocellular jaundice the

problem is in the liver so if we have

your nice liver here

here is your biliary system the problem

is in the liver itself

third question patient with jaundice

increased unconjugated bilirubin and

conjugated group but the conjugated

bilirubin is higher than the

unconjugated bilirubin both ast and alt

are high ALP is off-the-charts very high

GGT same thing very high what's the

diagnosis please it's an obstructive

jaundice so if we have your nice liver

right here and your biliary system here

where is the problem

biliary system obstruction in the

biliary system called obstructive

jaundice

so ast and alt are mildly elevated but

ALP and GGG are very high let's go to

question number four a patient with

epigastric pain radiating to the bank

fever increased amylase and lipase this

is easy and the answer is this is

pancreatitis

question number five patient with fever

right upper quadrant pain jaundice dark

urine increased alt and ast they

arranged between four hundred and four

thousand international units ALP is kind

of mildly elevated and by the way alt is

higher than ast what's the diagnosis and

the answer is this is hepatitis number

six fever right upper quadrant pain

jaundice dark urine very high

transaminases they are even higher than

ten thousand international unit Wow

ALP is normal to mildly elevated and by

the way alt is higher than ast what's

the diagnosis this is acetaminophen

toxicity greater than 10,000 units

doesn't have to be higher than 10,000

unit I'm just giving you an example to

let you know that the alt and ast will

be extremely high way higher than viral

hepatitis

next fever right upper quadrant pain

jaundice dark urine alt and ast are high

but they are less than 400 international

units ALP is normal to mildly elevated

GGT is high by the way ast is higher

than alt what's the diagnosis yep this

is the exception alcoholic

fatty liver or alcoholic steatohepatitis

and here is the last question fever

right upper quadrant pain leukocytosis

increased bilirubin increased alcohol

phosphatase high amylase and lipase

what's the diagnosis this is biliary

pancreatitis Wow

please let me know in the comment

section how many questions did you get

correctly without cheating and don't

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